Wednesday, October 17, 2012

How to increase breast milk supply, or make the most of what you have

I never had a doctor mention to me that I had any risk of supply issues, and had several doctors and nurses give me some very bad advice on how to deal with them.  They ranged from "your baby's getting what she needs despite the fact that she's crying all the time and can't sleep." to "just wait, your milk will come in," to "well if your milk hasn't come in by now (five days after delivery) it's not going to come in so you might as well just give up and use formula."  I can't believe how un-informed I found everyone from  the hospital maternity ward staff to my own personal OB!  I mean, it is your job to advise and care for women who have just had a baby, and to make sure that both mother and baby are cared for properly.  One would think that you could recognize that I have SEVERAL of the most severe risks for supply issues and at least warn me that I may have some work ahead of me!

Especially since supply issues are not the end of breast feeding, and there's a lot that can be done to head them off at the pass, but because I didn't know I had supply issues until nearly two weeks after my baby was born I am STILL constantly playing catch-up.  It also seemed like so many caregivers in the hospital were actually afraid to offer any advice.  For example, when my baby had jaundice I kept hearing over and over that hydration was the most important thing to focus on, and that I needed to make sure my baby stayed hydrated, but no one would tell me HOW!  I mean, this was a day or two after she was born, so of course I had next to no supply yet (no one does at that stage) and I was nursing her every 2-3 hours for 30 minutes at a time.  That's what they said I should do, and yet she obviously wasn't getting enough (not enough wet diapers) and the jaundice was getting worse!

Even once I did know I had supply issues I got conflicting advice from doctors, nurses, parenting books, and lactation consultants.  For example my lactation consultant said to supplement the baby with 1-2 oz of formula before each feeding and then finish up on the breast so she comes to associate me with satiation, while my baby's pediatrician said to breastfeed first when she's hungry and will go after it more and finish up on the bottle.  With such conflicting advice, and so many sources that completely ignore breast feeding supply issues I want to share what I've managed to glean about ways to improve supply and get the most you can or your baby.  I really feel the need to consolidate everything I learned and to let other women going through this know it's NOT that uncommon!

So first some of the worst advice I got starting from the very beginning:
"Don't worry about her nose, it's pointed down so she can always breath, and if she needs to breath better she'll just adjust."  Um, no.  You can definately smother a baby with a boob.  Yes, she'll notice if she's not getting enough air and adjust, but that adjustment will mean pulling back and letting go of her latch to gasp for air.  Which will mean you have to go through the process of re-latching over and over.  This leads to slower nursing (since she's not staying on) and nipple soreness from the re-latching.  For goodness sake tilt her head back or push your boob down so she can breathe!

"Just wait and your milk will come in."  In actuality the longer you wait to deal with a supply issue the more you'll be playing catch-up.  I'm STILL playing catch-up over two months later and there's a LOT you can do to improve things, the earlier the better.

"You don't need a breast pump."  The truth is, the more you empty your breasts, the more they will realize that they need to be making more.  The best way to empty your breasts is by baby, but babies get tired, their appetites wax and wane, they sleep through feedings, and you want to make sure you're emptying every last drop!  One of the best ways to increase production is to pump and feed frequently.  There are lots of different techniques and schedules that can help, and I'll discuss that more later, but suffice it to say I wish I'd gotten the pump when I first wanted to rather than listening to the hospital staff and putting it off until after they said I needed it.

"Fifteen minutes on each breast is enough." Ha!  The more stimulation your breasts get the better, and if your baby's tired or is a sleepy nurser like mine was then she may not be working at it that full 15 minutes, so your breasts may not be empty after 15 minutes.  Once I found out I had supply issues I'd feed her for over an hour at a time switching back and forth between breasts to help keep her awake and interested.

"You need to feed her 6-8 times a day."  More like 10 or more.

"You shouldn't supplement with formula."  You need to get 8 wet diapers a day, and if you're not getting that then you need to do what it takes to do that.  We were getting 4.  We told the lactation consultant that and she wigged out!

"Drink a beer as soon as you deliver, and every day after and you won't have any problems."  I heard this over and over, and always from women who'd had copious supply and could AFFORD to pump and dump.  Just when am I supposed to be drinking my beer?  All the books say not to drink within 2 hours of breast feeding, so I have the option of drinking a beer bright before I pump or drinking a beer right before I go to bed with my baby.  Neither of which makes sense when I'm trying to give every drop for my child.  Of course there is barley water and we'll talk more about that when we talk about what you can do for your diet to help.

So now you know what not to listen to, how do you get started trying to establish a good supply.  Keep in mind I'm not any sort of medical professional.  All I know is what I learned with my one baby.  So take everything I say with a grain of salt, I may have no idea what I'm talking about.  It starts before your baby is born.  Have your thyroid checked.  Have your complete blood count checked.  Make sure that your hormones are working and that you're not lacking in any nutrients.  Keep taking your prenatal vitamins and supplement to make up for any deficiencies.

Once you have your baby nurse as frequently as you possibly can.  The more nipple stimulation that better.  In fact you might try the pump before your baby's born, just make sure you don't try this until you reach full term since this can trigger labor.  If you have a premi or a baby with health problems this may be harder than it sounds, this is where the pump comes in.  Use breast compression during nursing to help your baby get ALL the milk out, and once you're done with a feeding see if you can express out any milk remaining.  An empty breast is a breast in production mode, so basically you want to empty your breasts as often as possible.

If you need to supplement  do so guilt free!  You don't want to starve your baby, and you want plenty of fluid moving through your baby to clear out waste.  Just be sure you supplement very small amounts at a time.  This is where it gets really frustrating.  Formula seems to only come in 2 oz doses, but you'll probably only want to supplement .5 to 1 oz at a time to start.  I guess the formula companies want you to over-prepare what you need and dump it out when it doesn't get used?  You can however mix up 2 oz and stick it in the fridge, then pour out .5 of an ounce at a time to reheat when you need it, just be sure to use it up within 24 hours of mixing.

Supply can also change throughout the day.  You may have plenty first thing in the morning, but when it comes time for that last feeding at night don't have enough to satisfy for an hour much less a good night's sleep.  So you may find you need to supplement different amounts at different times of day.

I've been given conflicting advice on whether to breastfeed first or supplement first, so I've tried to do a combination.  After all, I have two boobs!  So I generally start with one breast, supplement  then feed from the other breast.  This takes practice to know how much to supplement   If you give to much your baby won't be interested come the second breast, which isn't good for your supply.  If you give to little then you'll end up giving more late because your baby will be hungry, so the whole issue of what your baby comes to associate with satiation comes into play.  And as a baby goes through growth spurts his apatite will change, so it really can keep you on your toes constantly adjusting what you're doing.

Use wide neck bottles!  I'd bought a really nice set of Dr. Brown's bottles before the baby was born, only to be told that these can cause nipple confusion when you try to use them while breast feeding.  The wider nipples are supposed to latch more like your breast, so your baby won't get as confused about what to do when presented with either.  How you offer the bottle makes a difference too.  Don't just pop it in your baby's mouth nipple down.  Gravity will make it flow faster, and if your baby gets used to the faster flow then this can lead to frustration when they go back to the breast.  Hold the bottle horizontally, tilted so there's just enough milk to fill the nipple.  This way your baby has to work for it, and it has the added bonus of helping to prevent the baby from overeating.  After all, it hurts to work so hard to give him what breast milk you can, only to have it spit right back up at you!

There are a variety of herbs that can be used to help increase supply including milk thistle, and fenugreek, and proprietary blends like More Milk and More Milk Plus.  Keep in mind if you have thyroid issues that fenugreek can lower T3 hormone, so go for straight milk thistle or plain More Milk (not More Milk Plus) if you're worried about your thyroid.  These can be harder to find in stores, but you can order them online.  I saw a pretty fair increase in supply when I started on More Milk.

Eat well, and eat foods that can increase production.  This is not the time to go on a diet.  Be sure you're getting plenty of protein (eggs are a complete protein) and fat, and a wide variety of nutrients.  There are some foods that are supposed to help.  Oatmeal's the one I found most commonly recommended, but google lactation foods and you'll find lots of things to try.  A lot of folks recommended I drink a beer a day, but I tried a few alternative routes so that I could avoid having the alcohol in my system that is not good for the baby.  I cooked with beer.  This cooks out most of the alcohol, but leaves the rest behind, besides beer in chili is good!

You can also make your own barley water which has all the good stuff of beer without the alcohol, and it's not as nasty as it sounds.  You basically want to add a cup or two of barley to a LOT of water and then boil the heck out of it.  I found a recipe that called for about a cup of barley to two liters of water (or about two cups of barley if I filled up my largest soup pot with water).  Bring the water to a boil and then reduce the heat to a simmer for several hours until it's reduced by half.  You can then strain out the barley and eat it or throw it out (I added it to soup) and let the water cool for drinking.  I tried several things to make this more palatable.  You can add sugar and lemon to make a kind of thick lemonade, or add a dash of lemon to each glass for lemon water.  I would also sometimes mix it half and half with a strong flavored juice I liked (cranberry grape worked well), but milder juice like apple seemed to be overwhelmed by the barley water.

No matter what you're drinking, you want to make sure you're drinking plenty to stay hydrated.  After all, you're drinking for two now, and much of what you're drinking is being passed on to your baby.  You don't want to get dehydrated.

You'll also want to be sure you have a breast pump.  I read a lot of suggestions that sound like good ideas but don't really work in the real world.  Who has enough hands to hold a wriggling baby to one breast and a pump to the other simultaneously?  Some folks suggested pumping after every feeding to make SURE the breast was empty, but I never seemed to have time for that.  However I do pump when I wake up in the middle of the night, if it looks like she's going to sleep through a feeding, and very frequently during my work day to try to make things as empty as possible.  The type of pump you use does matter.  I've heard some women swear by the medicinal grade pumps that can be rented, and I wish I'd tried one of these before I bought the one I'm using.  Some women have better results with different flanges.  I got a lot of advice that suggested you should try different pumps, but at $300 to buy a decent electrical pump, or $50 a month to rent that could get very expensive very quickly.

Every little bit of breast milk you can give your baby helps.  It cuts down on tummy ailments and helps your baby's immune system.  Even with all that I've tried I still only make about a third of what my baby needs, but it's worth it to know I'm doing what I can to keep her as healthy as possible.

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